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The Right Balance: Using Physical Abilities Testing to Reduce Injuries

Since 1998, the American workforce has been increasing its speed to meet higher levels of productivity demands. With fewer employees doing the same amount of work, the instance of slips, trips and falls continues to rise.

The Bureau of Labor Statistics cites a 37 percent jump from 1998-2007 in these types of injuries, with more than 25,000 slips, trips and falls reported daily. Reducing this statistic could start with pre-employment testing and incorporating balance exercises into a corporate wellness program, says Deborah Lechner, president of ErgoScience.

"In my observation there are both changes in the workforce and changes in the work environment that are influencing this dramatic increase in slips, trips and falls," she says. "It's not just the environment or the workers; it's the two things together."

Getting to the Center of Balance

A person's center of balance is shifting continually, no matter if they are standing still or running at full speed. For example, a worker who carries a load is shifting their center of balance to compensate for the change in movement.

"When we move our bodies, the brain senses that movement and the brain tells certain muscles to respond and maintain the balance; so there is a continual feedback loop," Lechner explains. "Movement sends signals to the brain and the brain sends signals to the muscles so that they respond in a way that helps us maintain our balance."
Obesity and previous injuries directly contribute to a worker's ability to react to a slip, trip or fall.

A person with normal body weight holds his or her center of gravity through or behind hip joints and in front of knee and ankle joints. In contrast, if a person is obese, the larger belly shifts the center of gravity way forward and moves it out in front of the knees. The muscles of the hips and the backs of legs all have to work to counterbalance this shift.

"When obese individuals encounter a slippery puddle, for example, they have more force to control which makes a fall more likely and they also often have weaker muscles to respond to the challenge than the healthy person," she says. "Other individuals who have a previous injury or illness may have somewhat weaker muscles, abnormal movement patterns and balance deficits. For those folks, the postural muscles might not be able to perform or respond as well to the brain's requests."

Recent studies detailed in the Journal of Sports Medicine and the Journal of Athletic Training have shown that people with back, knee, ankle sprains handle their postural control and balance mechanisms differently than those who do not have injuries that could cause instability.

In addition, medicines such as anti-depressants, anxiety pills, antihistamines, sleep aids and blood pressure prescriptions can have a significant effect on one's reaction time. Even over-the-counter pain relievers have been shown to affect balance, Lechner says.

Lastly, fatigue also can affect balance and reaction times. Employees working 10- to 12-hour shifts could suffer muscle fatigue, which changes the sensation and control of the joints to the brain. The worker's brain would then respond more slowly to messages to maintain balance if they encounter uneven surfaces, obstacles or slippery puddles.

"What is really important for people to understand is that even standing still balance is in play," Lechner stresses.

Implementing the Right Program

Pre-employment testing or a well-rounded balance initiative begins with analyzing current injury data.

A two-tiered approach should be followed; identifying both extrinsic and intrinsic factors that influence a company's slip, trip and fall rate, Lechner says. External influences include establishing which jobs, processes and locations are creating most of the injuries as well as the safety aspect of improving lighting, clearing walkways and providing proper personal protective clothing. Intrinsic factors can be addressed through conducting physical ability tests, which allow companies to hire people whose balance is adequate for the job.

"Before you try fixing a problem you have to know the extent of the problem, which jobs are responsible for most of the falls and whether the falls are occurring in new hires or the seasoned workforce," she says.

Pre-employment testing. If done within the physical requirements of the job, fall prevention can start during the pre-hire process, Lechner says.

"We do job analysis to figure out the balance requirements of the job and then develop a test that measures the applicant's balance abilities," she explains. "If there are job tasks that require working on ladders, stairs, walking outside in uneven terrain - even working inside and stepping over things, you have to test for those requirements."

The U.S. Office of Personnel Management cautions that certain factors should be considered before implementing pre-employment testing. The agency cites legal challenges because some tests unintentionally can screen out women and minorities, which is why an employer must have valid evidence justifying the measures. In addition, physical ability tests that measure heart rate, blood pressure, or other physiological factors are forbidden under the Americans with Disabilities Act. Lastly, there is always the risk that job candidates might injure themselves during the screening process.

Balance and wellness programs. Another fall prevention strategy is implementing agility and balance training for those who are already in the workforce, Lechner says. Integrating complementary health approaches such as yoga and tai chi into a company's wellness initiative could be the key to reducing slips, trips and falls with current employees. Currently, few fitness programs incorporate balance training.

The National Center for Health Statistics shows the prevalence of these practices in adults, especially yoga, which has grown into a $2.5 billion industry. There also are specific balance exercises that can be part of any conditioning program, such as standing on one foot, heel-to-toe walks, leg swings and various stretches.

The main challenge is getting employees who need balance training the most to participate.

"One of the challenges with traditional corporate fitness programs is that many of the people who participate in them are already fit," Lechner says. "Fitness programs that help obese persons, or persons with previous injuries are very different from those designed to help a healthy or fit person."

Financial incentives – whether it's in the form of bonuses or discounts on health insurance premiums – prizes or contests, have been shown to improve participation rates, she adds.